Electrohydraulic ventricular assist device

ABSTRACT

A unified system for implantation in the thorax and for cannulation to the blood circulatory system comprises an electronic controller for generating an actuating signal and an energy convertor for converting the actuating signal into a back and forth rhythmic displacement of the blood between a blood pumping chamber (BPC) and a volume displacement chamber (VDC). The BPC has an inflow port and an outflow port and converts the back and forth displacement into a rhythmic unidirectional displacement of blood from the inflow to the outflow port. The actuating signal is generated by a detector in response to the status of the BPC. A support unitary with the VDC supports the internal electronic controller, the actuating means, the BPC, and the detecting means in a compact structure and has a surface curvature compatible with the internal human sagittal and transverse chest wall curvatures. The BPC is arranged with the inflow and outflow ports oriented away from the support for ready cannulation to the circulatory system.

This application is a division of application Ser. No. 08/303,766, filedSep. 9, 1994 now U.S. Pat. No. 5,569,156.

BACKGROUND OF THE INVENTION

1. Field of the Invention

The present invention relates to the field of equipment and prothesis asa circulatory device aid for assisting or replacing the right and/or theleft ventricle of the natural heart. More particularly, this inventionis concerned with an electrohydraulic ventricular assist device whichintegrates several of the major components required for this type ofdevice into one component herein referred to as the Unified System whichis implantable into the human thorax.

2. Description of the Related Art

Cardiac transplantation using a natural heart taken from a donor andgrafting it into a recipient is now a relatively routine surgicaltechnique. Recent advances have resulted in an appreciable reduction ofrejection. However, practical transplantation is limited to theavailability of natural heart donors and effective immunosuppressivedrugs.

Clinical experience has shown that the cardiovascular circulation ofpatients in severe or total heart failure can be sustained with properright and left ventricular assist devices (RVAD and LVAD).

For these and other reasons, a number of mechanical circulatory deviceshave been designed to replace and/or assist the diseased natural heart.Total artificial hearts (TAH) and ventricular assist devices (VAD) havebeen valuable clinical tools in recent years with their primary benefitas a bridge to transplantation following acute cardiac failure.Currently many of these devices are large requiring multiple implantsites for various components and long tubes and wires to connect thesevarious components, thus they must be located in the abdominal cavity oroutside the body.

For serious cases of heart failure, one should aim for long tern supportrather than support limited in weeks, days or hours. In addition, it ispreferable to have an assisting device which can be used for both leftand/or right ventricular support. Typically, devices for assisting theleft ventricle are located in the abdominal cavity or outside the chest.Traditional artificial hearts fit less than ideally inside the chest.

Generally, the requirements for a ventricular assist device are multipleand not easy to satisfy, It is desirable that such device be implantedin the thoracic cavity. The intra-thoracic blood pumping components ofthe device must be similar in size and weight to the natural heart. Theartificial heart life must be sufficiently long and the reliabilitysufficiently high to avoid the risk of sudden prosthesis failure. Theformation of adherent thrombus must be prevented. Thromboemboli andextensive blood damage must also be prevented. The device must notdamage adjacent tissue or traumatize adjacent organs by compression orby excessive local temperatures. The artificial hearts must also avoidskin penetration by connections to the exterior to prevent infections.As well, shortening of the length of the artificial blood vessels orcannulae employed for connecting the device to the natural heart orcirculatory system is another desirable requirement for the device.

There has been a great deal of development activity in the area ofartificial hearts, and especially for devices to assist the leftventricle (LVADs). Generally, a ventricular assist device comprises anelastomeric blood chamber or diaphragm capped cavity. The blood chamberis provided with an inflow and an outflow valve for connection to thecirculatory system. The blood chamber volume is controlled with theelastomeric diaphragm which is actuated to oscillate between a systolicand a diastolic position.

To transform electrical power generated outside the body into therhythmic movement of the diaphragm while obtaining suitable values forthe above parameters and thermodynamics, various types of energyconvertors have been tested.

The displacement of the diaphragm is obtained by various methods. Amongthese, electrohydraulic operation of the diaphragm proves to be adependable and reliable method. Electrohydraulic ventricular assistdevices are provided with a pump which displaces a hydraulic fluid (oil)between a fluid reservoir and a fluid chamber, which is adjacent withthe blood chamber so as to share the elastomeric diaphragm. The rhythmicfill and drain of the oil, in and out of the fluid chamber, displacesthe diaphragm which in turn moves the blood in and out the bloodchamber.

Canadian Patent No. 1,188,852 (Robinson) discloses a hydraulicallyactuated cardiac prosthesis with a hydraulic fluid reservoir, ahydraulic fluid pumping means and a blood pumping chamber with aflexible diaphragm. U.S. Pat. No. 4,222,127 (Donachy et al.) disclosesthe Pierce-Donachy artificial heart including a blood pump, flexiblediaphragm and an inflow and an outflow valves which can be usedparacorporeally or intra-thoracically. U.S. Pat. Nos. 4,588,404(Lapeyre) and 5,089,018 (Lapeyre et al.) disclose a biventricularcardiac prothesis. The device is a sealed case with a dual membranesystem for pumping the systemic and pulmonary circulations.

However, a major limitation of these past devices is their physicalshape, size and complexity which increase the surgical difficulty ofimplanting the device in either the thorax or abdomen of a patient.Power and information transfer requirements of the past devices havealso required percutaneous access to the implantation site with itsassociated risk of infection. These limitations have also had an effecton the length of time that these devices can be implanted.

Recently, devices for establishing communication of electrical signalsbetween the implanted device and an external power source andelectronics controller have been developed as disclosed in CanadianPatent application No. 2,007,439 {(2,074,150} (Miller) and U.K PatentNo. 2239802E (Miller). Such transcutaneous energy transformers employelectromagnetic induction using a pair of coupled coils, one outside andone inside the patient body. The ventricular assist device then can havean internal control mechanism for adjusting the frequency of oscillationof the diaphragm. To maintain maximum power transfer as the coils moverelative to one another, a phase locked loop system in the externalpower converter maintains a constant phase relationship between voltageand current in the primary coil, thus minimizing voltage fluctuations.This was disclosed by Mussivand et al. (Performance evaluation of atranscutaneous energy transfer system, ASAIO Abstract 21:39, 1992).These patents and this article are incorporated by reference.

The bidirectional communication of information between the implanteddevice and its portable external control unit is achieved by an infrareddata link. Data is transmitted across the skin without perforating itusing a standard synchronous data transmission protocol. This protocolawards hardware compatibility with any computer having an RS232 typeinterface. It was disclosed by Miller J. et al. (Performance Evaluationof a transcutaneous infrared telemetry system, ASAIO Abstr 21:39, 1992).

An ideal artificial heart device should integrate the major pumping andcontrolling components into a single Unified System for reducing thelength of the electrical connections and of fluid conduits. There arealso requirements for a material that should be accepted by the humanbody. Fluid dynamics of the device should not cause thrombus formationsand the potential for thromboemboli.

Anatomical fit has a significant impact on the case of surgicalimplantation, organ compression, patient comfort and postoperativecomplications. The internal body cavity dimensions have been recognizedas a prime limitation in the design of implantable, mechanicalcirculatory devices.

To date no comprehensive fundamental system has been patented thatprovides for the integration of the major components into a compact,lightweight, totally implantable unit which can be implanted in thechest cavity.

OBJECTS OF THE INVENTION

It is an object of the present invention to provide a totallyimplantable circulatory device which integrates the major components ofthe system into a single Unified System which is small enough to implantin a patient's body without giving rise to any serious clinicaldisadvantage or inconvenience to the recipient's organs. Thisintegration will result in a reduction of the number of surgical sites.The device of the present invention takes into account the best locationfor implantation in the patient and the best shape which is compatiblewith this location.

It is another object of the present invention to provide a ventricularassist device which can be fixed into the human chest in the proximityof the natural heart thereby shortening the length of the artificialblood vessels or cannulae employed for connecting the device to thenatural heart. This will result in a reduction in cannulation lengths tothe natural heart, thus reducing hydraulic resistance, kinking,turbulence, separation and recirculation of the blood and reduces thesurgical complexity associated with implanting other cardiac protheses.

It is another object of the present invention to provide a vehicularassist device with a reduced fluid conduit length, which further allowsfor the hydraulic fluid to be used not only to actuate the device andact as a bearing lubricant, but also to remove heat from the device andto disperse it via the lungs and the circulatory system.

It is still another object of the present invention to provide anelectrohydraulic ventricular assist device having a design which allowsfor shorter electrical connections due to the integration of the majorcomponents.

It is a further object of the present invention to provide anelectrohydraulic ventricular assist device which due to theconfiguration is suitable for use as a right, left or bi-ventriculardevice. This will result in a device which can be used in a wider rangeof patient population and diagnosis,

It is a further object of the present invention to provide anelectrohydraulic ventricular assist device with a portion of the controlelectronics integrated into the back of the Unified System and theremainder of the control electronics to be provided on a small portableunit to be worn on a belt thus eliminating the requirement for tetheringthe patient to a large bulky external console to drive the device.

It is a further object of the present invention to provide a UnifiedSystem which can be secured to the rib cage to prevent migration and theresulting organ compression.

It is a further object of the present invention to provide a systemwhich can be adapted to many different geometrical configurations tomeet the requirements of different actuating means, within the overallconstraints of the invention. This further allows for the use of thebest possible actuating means and resulting geometry while retaining allthe advantages of the present invention.

SUMMARY OF THE INVENTION

According to the present invention, there is provided a unified systemfor total implantation in the thorax of a patient and for cannulation tothe circulatory system comprising: an internal electronic controller forgenerating an actuating signal; a blood pumping means with an inflowblood port and an outflow blood port for cannulation to the bloodcirculatory system; said pumping means displacing blood through saidinflow and outflow ports in response to said actuating signal; and saidunified system being contained within a housing the back of which has aconvex surface curvature compatible with the internal human sagittal andtransverse chest wall curvatures said housing containing a support forsaid internal electronic controller and containing said blood pumpingmeans in a compact structure with said inflow and outflow ports orientedaway from the front of said housing, and said structure having anoverall size and geometry such that when the unified system is placedwithin the human thorax with the back of said housing adjacent the chestwall, said structure does not adversely compress adjacent organs, createdead space or limit chest closure.

In accordance with another aspect of the present invention, there isprovided a unified system for total implantation in the thorax of apatient and for cannulation to the blood circulatory system comprising:an internal electronic controller for generating an actuating signal;actuating means for converting said actuating signal into a back andforth pulsating rhythmic displacement of a fluid; a blood pumpingchamber having an inflow blood port and an outflow blood port forconverting said back and forth displacement of said fluid into arhythmic unidirectional displacement of blood through said inflow andoutflow ports; hermetic coupling means for providing said internalelectronic controller with a supply voltage; detecting means fordetecting the status of said blood pumping chamber and accordinglygenerating a control signal to said internal electronic controller forsynchronizing said actuating signal; a volume displacement chamberacting as a reservoir for said back and forth rhythmic displacement of afluid; and a housing the back of which has a convex surface curvaturecompatible with the internal human sagittal and transverse chest wallcurvatures for containing said internal electronic controller, saidactuating means, said blood pumping chamber, said hermetic couplingmeans and said detecting means in a compact structure with said bloodpumping chamber arranged with said inflow and outflow ports orientedaway from the front of said housing and said structure having an overallsize and geometry such that when the Unified System is placed within thehuman thorax with the back of said housing adjacent the chest wall, saidstructure does not adversely compress adjacent organs, create dead spaceor limit chest closure.

In a further aspect there is provided a Unified System for anelectrohydraulic ventricular assist device adapted for implantation inthe thorax and for cannulation to the blood circulatory systemcomprising: an internal electronic controller for receiving both an ACand DC supply voltages, an external communication channel data streamand generating an actuating signal, communication channel data streamand internal battery recharging signals; an actuating means forconvening said actuating signal into a back and forth rhythmicdisplacement of a fluid; a blood pumping chamber having an inflow bloodport and an outflow blood port for converting said back and forthdisplacement of said fluid into a rhythmic unidirectional displacementof blood through said inflow and outflow ports; a volume displacementchamber acting as a reservoir for said back and forth fluiddisplacement; a hermetic coupling means for connecting said controllerby conductors carrying said AC/DC supply voltages, said communicationchannel data streams and internal battery recharging signal; a detectingmeans for generating said actuating signal in response to the status ofsaid blood pumping chamber; and a housing the back of which has asurface curvature compatible with the internal human sagittal andtransverse chest wall curvatures for containing said electroniccontroller, said actuating means, said blood pumping chamber, saidhermetic coupling means and said detecting means in a compact structurewith said blood pumping chamber arranged with said inflow and outflowports (and one way valves) oriented away from the front of said housingand said structure with an overall size that when the Unified System isplaced within the human thorax with the back surface of said housingadjacent the chest wall, said structure does not adversely compressadjacent organs.

According to another aspect of the present invention, there is provideda Unified System wherein the back of said housing has an averagelongitudinal radius of curvature of 22 cm±5 cm, and an averagetransversal radius of curvature of 10 cm±2 cm.

According to still another aspect of the present invention, there isprovided a Unified System further comprising a first cannula connectedto said inflow port for cannulation with the blood circulatory system.Said inflow port is oriented for cannulation to the systemic circulationwhen the Unified System is implanted in the thorax for assisting orreplacing a left ventricle. The length of said first cannula is between1 and 5 cm. A second cannula, which may have a length of between 5 and14 cm, is connected to said outflow port is oriented for cannulation tothe systemic circulation, when the Unified System is implanted to thethorax for assisting or replacing a left ventricle. Said inflow port isoriented for cannulation with the pulmonary circulation when saidUnified System is implanted for assisting or replacing a rightventricle. Said outflow port is oriented for cannulation with thepulmonary circulation when said Unified System is implanted forassisting or replacing a right ventricle.

Acceding to still another aspect of the present invention, there isprovided a Unified System having an overall thickness of less that 4 cm,an overall length less than 18 cm and an overall width less than 12 cm.

The device according to another aspect of the present invention isadapted for cannulation to the blood circulatory system and comprises:said Unified System for implantation in a human thorax proximal to thehuman heart to replace or assist a ventricle; a rechargeable internalbattery for subcutaneous implantation to supply said Unified System withan internal DC supply voltage; an external battery for providing a DCvoltage to an external controller; said external controller forconverting DC voltage received from the external battery and/or externalpower supply to AC voltage for transfer by a transcutaneous energytransformer to power said Unified System, for recharging the externalbattery; a computer interface for connecting said device to a computerfor control and monitoring of the device; a display means for controlstatus and alarm display; a transcutaneous energy transformer fortransmitting said AC voltage across the skin to said Unified System; atranscutaneous information telemetry system for bidirectionaltransmitting said communication channel data streams between saidexternal controller and said Unified System; a connector for connectingsaid internal battery to said Unified System and an in-line connectorfor connecting said transcutaneous energy transformer to said UnifiedSystem.

The Unified System is totally implantable within the chest cavity andrequires no physical connections (tubes and wires) through the skin tothe outside of the body. The device is powered by either an implantablebattery or a transcutaneous energy transfer system. The device iscontrolled and monitored remotely via a transcutaneous informationtelemetry or by said internal electronic controller. This will result inthe elimination of potential infection sites caused by perforations inthe skin.

According to the present invention, by integrating the major componentsin one unit, some components act as housings for other components. Thiswill result in an overall reduction in amount of housing materialsrequired, thus reducing the volume and weight which are majorconsiderations in this type of device.

In addition, the device of the present invention to provide a so calledUnified System which can be adapted for electrical, thermal, magnetic ormechanical actuation. This will result in the ability to select the bestpossible actuating means available at the time of design.

Anatomical fit has been a major limitation in artificial heart clinicalsuccess. Due to the size of these devices most are implanted in theabdomen or are outside the body. The volume, weight, geometricalconfiguration (dimensions and curvatures), integration of majorcomponents and placement are the main problems that this presentinvention addresses.

Advantageously, with the Unified System the major components areintegrated into one unit capable of being implanted in the thoracicchest cavity, thus eliminating abdominal implantation and the need forabdominal surgery. Thus the diaphragm will not be penetrated and theimplant will not cause problems for soft tissue organs in the abdomensuch as the spleen, liver, intestine, etc. which are easily disturbed.

Another advantage of the Unified System comprises reducing the risk ofinfection by eliminating the need for direct physical access fromoutside of the body to inside by perforation of the skin. Placing theUnified System in the chest cavity further allows for anchoring to thechest cavity ribs, thus preventing critical organ damage, migration,infection and other complications associated with traditional abdominalimplantation.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features of the invention will become more apparent fromthe following description in which reference is made to the appendeddrawings, wherein:

FIG. 1 illustrates a block diagram of the electrohydraulic ventricularassist device (VAD) of the present invention;

FIG. 2 is a front view of the implantable part of the VAD which willhereinafter be referred to as the Unified System, showing the surfacefacing the heart. Part is broken away to illustrate the fluid path;

FIG. 3 is a back view of the Unified System shown in FIG. 2 with theback cover removed;

FIG. 4 illustrates a back view of the back cover removed from FIG. 3;

FIG. 5a shows a transversal cross-sectional view along lines A--A ofFIG. 2, during the systolic phase of the cardiac cycle;

FIG. 5b shows a transversal cross-sectional view along lines A--A ofFIG. 2, during the diastolic phase of the cardiac cycle;

FIG. 6a shows longitudinal cross section view along lines B--B of FIG.2, during the systolic phase of the cardiac cycle;

FIG. 6b shows longitudinal cross section view along lines B--B of FIG.2, during the diastolic phase of the cardiac cycle;

FIG. 7a is a general top view of another embodiment illustrating analternative geometric configuration of the components;

FIG. 7b is a side view of the embodiment shown in FIG. 7a;

FIG. 8a is a general top view of another embodiment showing a furthergeometric configuration of the components;

FIG. 8b is a side view of the embodiment shown in FIG. 8a;

FIG. 9 is a general top view of mother embodiment showing a furthergeometric configuration of the components;

FIG. 10 is a detailed view of part of FIG. 6b, illustrating thedetecting means 9;

FIG. 11 is a detail diagrammatic view of external controller 53 shown inFIG. 1; and

FIG. 12 is a detail diagrammatic view of internal electronic controller3 shown in FIG. 1.

DESCRIPTION OF THE PREFERRED EMBODIMENT

Referring to the drawings, a preferred embodiment of an electrohydraulicventricular assist device in accordance with the present invention isdescribed.

FIG. 1 illustrates a block diagram of the electrohydraulic ventricularassist device of the present invention. A Unified System 1 incorporatesthe major units of an electrohydraulic ventricular assist device and issized for convenient implantation into the thorax and for facilecannulation to the blood circulatory system. The Unified System 1comprises an internal electronic controller 3 which receives a DC supplyvoltage on conductor set 5, an AC supply voltage and communicationchannel data stream on conductor set 7 and signals from detecting means9. The internal electronic controller 3 processes these signals andaccordingly generates an actuating signal on conductor set 10. Afunctional block diagram of controller 3 is shown in FIG. 12.

Actuating means 11 converts the actuating signal from electroniccontroller 3 into a back and forth rhythmic displacement of a fluid,causing a rhythmic fill and drain of a fluid compartment 13 of a bloodpumping chamber 15 with a fluid. A volume displacement chamber 17,diagrammatically shown in FIG. 1, acts as a reservoir for the fluid asit is displaced into and out of the fluid compartment 13. The bloodpumping chamber 15 has an inflow blood port 19 and an outflow blood port21. The blood pumping chamber converts the back and forth displacementof the fluid into a rhythmic unidirectional displacement of bloodthrough the inflow and outflow ports.

The implantable components of the electrohydraulic ventricular assistdevice of the present invention consist of the Unified System 1, inflowand outflow cannulae, an internal battery 45 and an internaltranscutaneous energy transformer (TET) telemetry unit 47 which may beof the type previously referred to on page 3.

The internal battery is connected to the Unified System 1 via hermeticconnector 49, electrical conductor set 5 and electrical feedthrough 25,as shown in FIG. 1. The internal battery 45 is preferably implantedsubcutaneously in the abdomen. In the preferred embodiment the internalbattery package 45 uses rectangular prismatic nickel/cadmium cells,however other battery chemistries could be utilized. These cells arehoused in a custom designed laser welded titanium enclosure with ahermetic connector 49 suitable for implantation. Preferably, thehermetic connector 49 is an internal connector, used for allowing aneasy replacement of battery 45. In this way, the part of conductor set 5from connector 49 through feedthrough 25 to Unified System 1, should notbe changed when internal battery 45 is replaced periodically. Theelectrical conductor set 5 contains electrical connections for thesupply of DC voltage to the internal electronic controller 3, for therecharging of the internal battery end for activation of an audiblewarning alarm housed in the battery enclosure.

The internal TET/Telemetry unit 47 is connected to the Unified System 1via the in-line hermetic connector 51, electrical conductor set 7 andthe electrical feedthrough 27. The internal TET/Telemetry unit 47 isimplanted subclavicularly.

The internal electronic controller 3 comprises a microprocessor whichgives the actuating signal for reversing the direction of rotation ofmotor 37. Detecting means 9 detects the position of the flexiblemembrane 31 and generates a signal to the microprocessor to indicatewhen membrane 31 has arrived at the end systolic or end diastolicpositions. Preferably, an infrared sensor is used as detector 9, whichis provided directly on the internal controller and adjacent to theblood pumping chamber 15, as shown in FIG. 10.

A block diagram of the internal controller 3 is illustrated in FIG. 12.The signals transmitted by the external TET/telemetry unit 55 throughthe patient's skin are received by the internal TET/telemetry unit 47and passed to power regulator 91 and telemetry system 92 over lines 7aand 7b. Power regulator 91 generates the DC voltage for supplying thecircuits of the internal controller 3. The telemetry circuit 92exchanges signals with the internal TET/telemetry unit 47 and withmicroprocessor 93. For example, an INTEL 87C196 may be used asmicroprocessor 93. Detection means 9 supervises the position of themembrane 31 and acknowledges when the membrane reached an extremeposition. Detection means may be an infrared detector, but otherdetectors, as a magnetic type sensor, etc may be used. Themicroprocessor 93 processes the acknowledgement received from thedetection means 9 and instructs a motor commutator unit 94 to generatethe actuating signal on conductor set 10. The motor commutator unit 94may be a MOTOROLA 33033 circuit. This signal reverses the rotation ofmotor 37 to accordingly pump the blood in and out of the blood pumpingchamber 15. Microprocessor 93 exchanges information with the externalcomputer through telemetry circuit 92. A battery charger 95 receives abattery charge control signal from the microprocessor 93 whenever thevoltage on the internal battery 45 drops under a threshold level.Battery 45 is charged over conductor 5.

The external components of the electrohydraulic ventricular assistdevice of the present invention consist of the external electroniccontroller 53, an external battery 61 and an external TET/Telemetry unit55, shown on FIG. 1.

The transcutaneous energy transformer (TET) and transcutaneousinformation telemetry (Telemetry) systems consist of electroniccircuitry on both the internal electronic controller 3 and externalelectronic controller 53, the internal TET/Telemetry unit 47 and theexternal TET/Telemetry unit 55. The TET uses wire coils 57, 57' toelectromagnetically couple power into the body without perforation ofthe skin. The Telemetry uses infrared components 59,59' embedded in theinternal TET/Telemetry unit 47 and external TET/Telemetry unit 55 totransfer the communication channel data streams into and out of the bodywithout perforation of the skin. The external TET/Telemetry unit 55 isconnected to the external electronic controller 53 via electricalconductor set 69.

The external electronic controller 53 contains a portion of thecircuitry for both the TET and Telemetry systems. External electroniccontroller 53 also produces and receives the communication channel datastream for control and monitoring of the Unified System 1 and generatesrecharging signals for recharging the external battery 61 atpredetermined intervals. The external electronics is a compact unitintended to be worn on a belt similar to a pager.

FIG. 11 illustrates diagrammatically in more detail the components ofexternal controller 53 shown in FIG. 1. FIG. 11 shows a power regulator80 which receives a DC or an AC supply from the mains power supply orfrom an external battery on input 67, 81. The connections 82 supply theother components shown in FIG. 11 with DC voltage. A DC to AC convertor83 transmits an AC signal over conductor 69a leading to externalTET/telemetry unit 55. A computer interface 63 establishes thecommunication between the external controller 53 and the externalcomputer 64 (shown in FIG. 1) over bus 85. Microprocessor 89 monitors atelemetry circuit 86 and LCD module 65. For example, an INTEL 87C196 maybe used as microprocessor 89. Signals to and from the externalTET/telemetry unit 55 are processed and communicated to the externalcomputer 64 through interface 63. Various messages and warnings may bedisplayed on the LCD module 65, as programmed. Telemetry circuit 86interface the signals exchanged between microprocessor 89 and externalTET/telemetry unit 57, which in turn transmits these signals to internalTET/telemetry unit 47, and further to internal controller 3.

The external battery 61 is connected to the external electroniccontroller 53 via electrical conductor set 67. In the preferredembodiment the external battery uses silver/zinc cells, however otherbattery chemistries could be utilized. The electrical conductor set 67,81 contains electrical connections for the supply of DC voltage to theexternal electronic controller 53 and for the recharging of the externalbattery 61.

FIGS. 2 to 6 illustrate the preferred embodiment of the implantable partof the electrohydraulic ventricular assist device which we refer to asthe Unified System. Where possible, the same numerals as those used inschematic FIG. 1 have been employed.

In the front view FIG. 2, actuating means 11 which includes the motor 37and the pump 39 (shown in FIGS. 5a and 5b) causes hydraulic fluid toflow between reservoir 17 and fluid compartment 13 (which in FIG. 2 isbehind blood pumping chamber 15 as apparent from FIGS. 5a and 5b). Theflow goes rhythmically backwards and forward through oil conduits 41 atone end of pump 39 communicating with compartment 13 and a short fluidconduit 41a communicating between pump 39 and reservoir 17. Cover 23 inFIG. 2 is partly broken away to illustrate conduit 41a. Conduit 41 isbroken away to show its interior.

FIG. 2 shows ports 19 and 21 which, as illustrated in FIGS. 6a and 6b,have cannulae 76 and 77 joined to the inflow blood port 19 and outflowblood port 21 respectively. Within cannulae 76, and preferably close toport 19 there is a valve 72 which opens inwardly. An outwardly openingvalve 73 is within cannula 77. The length of the outflow cannula 77 ispreferably between 5 and 14 cm. The length of the inflow cannula 76 isbetween 1 and 5 cm. The shorter the distance, the better. Cannulae withappropriate valves are readily available commercially.

The Unified System 1 is connected to the systemic circulation whenassisting the left ventricle or to the pulmonary circulation whenassisting the right ventricle. The connection is through inflow andoutflow cannulae 76 and 77 which include unidirectional valves 72 and 73and rigid connectors 74 and 75. For left ventricular assist, the inflowcannula 76 is connected to the apex of the left ventricle through ascalloped tip 78 at the end of the cannula. The outflow cannula 77consists of a small rigid connector in which the unidirectional valvesits and which is connected to a flexible cannula and ultimately is sewnto the aorta or to the corresponding blood vessels.

The unidirectional valves 72 and 73 may be any known valving apparatuswhich provide for substantially free flow of blood in one direction andsubstantially zero flow of blood in the opposite direction. Typicalexamples of such valves are disk, ball, bicuspid or tricuspid valves.The flexible cannulae 76 and 77 may be composed of a commerciallyavailable biostable material graft, such as a woven Dacron® graft (E.I.dupont de Nemours and Co. Inc.) while the rigid connectors are made fromanother commercially available biostable material, such as Tecoflexpolyurethane (Thermedics Inc.).

The transversal angle A₁ in FIG. 5 between the axial centre line a ofany of ports 19 and 21 and a base line b which is the approximatetransverse centre line, may range from about 25° to 140°, but ispreferably about 35°±10°. It is highly desirable that axial line a ofthe inflow port not be perpendicular to membrane 31 as otherwise theremay be a tendency of the blood to clot with the potentiality of causingan embolism.

In FIG. 6 the longitudinal angle A₃ between the approximate longitudinalcentre line c and axial line e of inflow port 19 may be between 25° to140°, but is preferably about 130°±10°. The angle A₂ between baseline cand axial line d of outflow port 21 may be between 10° and 140°, but ispreferably about 20°±10°. In each case, it is desirable that the axiallines of the ports not be perpendicular to the membrane 31.

The angles A₁ and A₃ determining the orientation of port 19 should beconsidered in combination so that the port has an anatomicallyconvenient direction and also does not have an axis perpendicular to themembrane 31. Similarly, angles A₁ and A₂ of port 21 should be consideredin combination. It is furthermore desirable that the axis of the inflowport not be perpendicular to the surface of cover 23.

Hermetic coupling means, namely feedthrough cover 23, illustrated inFIGS. 2 and 3, houses electrical feedthroughs 25, 27 which connect tothe conductors sets 5 and 7 carrying the DC supply voltage, AC supplyvoltage and communication channel data streams to the internalelectronic controller 3 and units outside the Unified System 1. An oilfiling port 43 is also mounted on feedthrough cover 23 for fillingvolume displacement chamber 17 with hydraulic fluid.

FIG. 3 illustrates a back view of the Unified System with the cover 29(shown in FIG. 4) removed. The internal controller 3 is preferablysegmented as exemplified by the bending lines 75 to provide someflexibility so that controller 3 can be substantially parallel to backcover 29 as shown in FIG. 6.

Cover 23, removable cover 29, conduit 41 and membrane 35 combine toprovide a sealed housing containing the entire implantable UnifiedSystem.

In the preferred embodiment represented in FIGS. 5 and 6, the bloodpumping chamber 15 has an elastomeric membrane 31 which converts theback and forth displacement of the fluid, driven by the actuating means11, into the rhythmic displacement of the blood.

The shape of the blood compartment 33 is flat and low ellipsoidal, as asac defining a back face and a front face, the back face being membrane31, and the inflow and outflow ports 19 and 21 protruding through thefront face. Membrane 31 divides the sac longitudinally in a plane normalto the axis of the blood pumping chamber 15 so that the height of themembrane oscillation is low. Membrane 31 defines a blood compartment 33and a fluid compartment 13. The blood compartment 33 is comprisedbetween the membrane 31 and the front face of blood pumping chamber 15.The fluid compartment 13 is comprised between membrane 31 and the backface of blood pumping chamber 15. Membrane 31 oscillates between asystolic position, where blood is displaced from the blood compartmentand a diastolic position, where the blood compartment is filled withblood. The shape of the blood pumping chamber allows the membrane totravel a short distance between the systolic and diastolic positions,this short distance improves the mechanical properties of the membrane,thus increasing long term reliability. The systolic and diastolicpositions of the membrane 31 and VDC membrane 35 are shown in FIGS. 5and 6.

The actuating means 11 is a so called energy convertor. Energy convertor11 converts the actuating signal received from the internal electroniccontroller 3 into a back and forth rhythmic displacement of the fluid.It comprises a brushless DC motor 37 and a reversible axial pump 39.Whenever motor 37 receives the actuating signal it reverses its rotationand accordingly the direction of fluid displacement by pump 39,converting this alternating rotational movement of the motor into a backand forth displacement of the fluid. The energy convertor 11 transfersfluid from the volume displacement chamber through the energy convertor11 and through oil conduit 41 and 41a to the fluid compartment 13. As aresult of this alternating fluid dislodgement the membrane 31 and VDCmembrane 35 oscillate alternately between the systolic (blood beingejected from the device) and diastolic (blood entering the device)positions. The brushless motor 37 has bearings which have an axialpreload to decrease ball skidding and thereby improve bearing life. Themotor stator is a toothless design and the permanent magnet material ismade of neodium iron boron which creates high magnetic field density.

The energy convertor 11 is arranged in the hydraulic fluid such that thehydraulic fluid is both a lubricant for the bearings in the energyconvertor 11 and a heat sink. In the embodiment shown in FIGS. 1 to 6the energy converter 11 is preferably placed towards the lower side ofthe Unified System, beside the blood chamber 15 to reduce the overalllength of the fluid path. The oil conduit 41 provides a fluid pathwayfrom one end of the energy convertor 11 to the fluid compartment 13 ofthe blood chamber 15 as shown in FIG. 3. The other end of the energyconvertor opens substantially directly via passage 41a into the volumedisplacement chamber 17.

As previously explained, detecting means 9 which is preferably aninfrared sensor, monitors the position of membrane 31 and generates asignal to a microprocessor 93 forming part of internal electroniccontroller 3.

As illustrated in FIG. 10, detecting means 9 includes transmitters 46which generate a signal illustrated by dotted line 44. This signal isreflected back by membrane 31 and received be receivers 45. Thereceivers 45 feed the signal to microcontroller 93 (see FIG. 12).

As shown in FIGS. 2, 5 and 6, the blood pumping chamber 15 and thevolume displacement chamber 17 are placed side by side. These chambersdefine a space at the back thereof to accommodate the internalelectronic controller 3 which is placed directly beside the energyconvertor 11 and connected thereto, as illustrated at 10 in FIG. 3. Thisplacement of the energy convertor 11 close to controller 3 allows shortelectrical connections, reduces electrical losses and increases thereliability and efficiency of the Unified System.

The operation of the device is now further described. The system isactuated by the hydraulic fluid that is pumped between the volumedisplacement chamber 17 and the fluid compartment 13 of blood pumpingchamber 15, by the reversing axial flow pump 39 driven by the brushlessDC motor. Whenever the motor 37 receives an actuating signal from theinternal electronic controller 3, it reverses its direction of rotationwhich causes a reversal in the flow direction of the actuating fluid.

Actuating fluid is pumped into the fluid compartment 13 of the bloodchamber 15 and the membrane 31 displaces the blood during the systolephase of the cardiac cycle through the outflow port 21. When the axialflow pump 39 is reversed, the hydraulic fluid is pumped away from thefluid compartment 13 of the volume displacement chamber 17, causingoutward displacement of the VDC membrane 35, the membrane 31 is pulledaway from the blood compartment 33 causing active filling of blood tooccur through the inflow port 19. This action is further illustrated inFIGS. 5 and 6. Reversal points of the axial pump 39 are determined bythe membrane position detector 9 which sends the status signal to theexternal electronic controller 3 for reversing the axial pump flow whenthe membrane 31 reaches the end points of systole and diastole.

The entire structure has an overall size and shape such that when theUnified System 1 is placed within the human thorax with the support 29adjacent the chest wall, the Unified System does not adversely compressadjacent organs. The blood pumping chamber is arranged with the inflowand outflow ports 19 and 21 arranged such that the cannulae 76 and 77are oriented towards their respective destinations of the bloodcirculatory system.

It is important that the dimensions of the human chest cavity be knownfor designing the shape and size of the Unified System. The spaceavailable for intra-thoracic placement of the device is very limited.The implantation site for the Unified System of the present invention isin the left and/or right hemithorax anchored to the chest wall betweenthe 4th and 9th ribs. Advantages of this placement include limiteddevice migration when fixed to the ribs, cosmetic acceptability, shortercannulae lengths and therefore less hydraulic losses, less potential forkinking of the cannulae, no need to penetrate the diaphragm andelimination of risk of possible pressure necrosis of abdominal organs.

The size and shape of the back cover 29 are selected to snugly fit thegeography of the ribs against which the device is arranged whenimplanted.

A prime consideration in the back cover design is the chest wallcurvature. Any pockets formed between the device and chest wall wouldcreate dead spaces and a potentially increased risk of infection. Thetransverse radius of curvature of the intra-thoracic wall at the 5th ribwas determined to be 9.4±0.5 cm (n=19) as disclosed by Mussivand T. etal. (Critical Anatomic Dimensions for Intrathoracic Circulatory AssistDevices, Journal of Artificial Organs, June 1992, Volume 16 #4).

Another important measurement in the design of the Unified System is thesagittal radius of curvature at the 5th rib. This was measured to be11.1±0.5 cm. Knowledge of this dimension is necessary for the design ofthe longitudinal curvature of the device.

Back cover 29 has a longitudinal and transversal curvature to provide aconvenient shape complementary to the thorax sagittal and transverseinternal curvatures. The average longitudinal curvature of back cover 29is illustrated in FIG. 6 as R₂, and is 22 cm±5 cm at the given section.The average transversal curvature of back cover 29 is illustrated inFIG. 5 as R₁, and is 10 cm±2 cm at the given section. In practice, thelongitudinal radius of curvature of back cover 29 will be about radialcentres that move a few centimeters from left to right of FIG. 6, sothat at each end there is close conformity to the sagittal radius ofcurvature, but there will be some flattening intermediate its ends.

The Unified System of the present invention has an overall thickness ofless than 4 cm, an overall length less than 16 cm and an overallexternal width less than 11 cm. It gives a cardiac output of greaterthan 8 liters/minute with a mean preload pressure of between 5 to 10 mmHg and a mean afterload pressure of 150 mm Hg, with the Unified Systemof this invention, the stroke volume of the blood pumping chamber isbetween 55 and 70 ml.

Experimental Investigation

Anatomical

In order to determine the size and geometrical constraints of theUnified System for an intrathoracic placement, thoracic dimensions incadavers and fit acceptability in live patients has been assessed todetermine the acceptable size of the device for the present invention,some preliminary estimates of the size constraints in the left thoraciccavity were obtained using disc models of varying thickness anddiameters. Disks with 2 cm to 6 cm thickness and diameters between 8 cmand 12 cm have been placed in the intended implant location of the leftanterior chest wall of cadavers, after a chest wall incision. Themaximum disk thickness and diameter that could fit into cadaver, withoutcausing organ compression was recorded. Chest cavity dimensions wereobtained during the autopsy of nineteen cadavers, eight within 24 hoursof death and eleven preserved cadavers. A total of 19 cadavers were usedfor the experiments, the sizes are given in Table 1.

                  TABLE 1                                                         ______________________________________                                                           Height (cm)  Weight (kg)                                   Cadavers n         Mean ± SEM                                                                              Mean ± SEM                                 ______________________________________                                        Fresh                           65.6 ± 9.0                                 Male     4         175.0 ± 5.6                                                                             88.0 ± 4.6                                 Female   4         158.5 ± 4.2                                                                             43.2 ± 5.0                                 Preserved                                                                              11        174.8 ± 1.6                                                                             70.9 ± 4.6                                 Male     10        179.9 ± 1.4                                                                             73.7 ± 4.0                                 Female   1         165.0        45.0                                          Total    19        171.2 ± 2.3                                                                             68.5 ± 4.6                                 ______________________________________                                    

The cadaveric anatomical dimensions that were measured which aresummarized in Table 2.

                  TABLE 2                                                         ______________________________________                                                            Distance (cm)                                             Anatomical Dimension                                                                              Mean ± SEM                                                                            Range (cm)                                     ______________________________________                                        Left ventricular apex to chest wall                                                                2.8 ± 0.3                                                                            1.5-3.5                                        Midline anterior-posterior                                                                        10.6 ± 0.6                                                                             6.0-14.5                                      Root of the aorta to the diaphragm                                                                 8.6 ± 0.4                                                                             7.0-10.0                                      Sternum length      18.9 ± 1.2                                                                            12.0-24.0                                      Thorax width at 1st rib                                                                           15.6 ± 1.2                                                                            10.5-21.0                                      Thorax width at 5th rib                                                                           24.6 ± 0.5                                                                            20.0-30.0                                      Thorax width at 9th rib                                                                           28.4 ± 2.2                                                                            18.0-35.0                                      Midline to left lateral chest wall                                                                12.2 ± 0.7                                                                             9.5-14.0                                      4th-9th rib vertical midclavicle distance                                                         16.3 ± 1.8                                                                            12.0-22.0                                      Sagittal radius of curvature at 5th rib                                                           11.1 ± 0.5                                                                             9.0-12.0                                      Transverse radius of curvature at 5th rib                                                          9.4 ± 0.5                                                                             8.5-l0.0                                      ______________________________________                                    

The most critical dimension that defines the configuration of the devicewas the ventricular apex to the chest wall which was found to be 2.8±0.3cm. The sagittal radius of curvature at the 5th rib was found to be11.1±0.5 cm and the transverse radius of curvature at the 5th rib wasfound to be 9.4±0.5 cm.

An epoxy model of one of the Unified System configurations was madebased on these cadaveric anatomical dimensions. In addition, sixsterilizable epoxy version models of this design were available forintraoperative fit trials. Following informed consent, the prototypemodels were placed in the left chest cavity in patients varying inweight from 65 to 100 kilograms and heights from 155 to 190 centimeterswho ware undergoing various cardiac procedures.

The following was concluded based on the cadaver fit trials andintraoperative patient fit trials:

1. That a model having a thickness of less than 4 cm and a diameter of11 cm with a sagittal and transverse curvature of 11.5 and 9.4 could beaccommodated in the intrathoracic cavity of the cadavers studied withoutsignificant compression of vital structures such as the heart and leftpulmonary hilus.

2. That with intrathoracic positioning of the device, outflowcannulation could be routed anteriorly over the lungs to the root of theascending aorta. The length of the inflow cannulation would be veryshort due to its proximity to the left/right ventricular apex.

3. That the size of the device could be no larger than 18×12×4 cm forthe size of human bodies studied.

4. That various geometrical configurations of the device are feasibleprovided that they are within the size and shape constraints outlinedabove. Some of these different geometrical configurations areillustrated in FIGS. 7, 8, and 9.

In Vitro

Testing was conducted in vitro to verify that the system operatedsatisfactorily prior to any in vivo experiments. Tests have beenconducted on mock circulation with the device in air and completelysubmerged in saline solution to simulate expected chest pressures. Invitro flow rates of over 8 liters per minute with a proload of 10 and amean afterload of 100 mm Hg have been obtained. The transcutaneousenergy transformer has demonstrated a power transfer efficiency of over80% at power levels of 10-35 Watts. The internal and the externalbatteries have been cycled tested to determine optimum charge anddischarge requirements as well as to determine operating times and cyclelives.

In Vivo

The complete Unified System has been implanted in 10 bovine for in vivotesting and has maintained circulation from 3 to 96 hours. Theperformance of the complete Unified System has proven satisfactory inacute experimentation. The overall configuration of the device has alsoproven to be satisfactory, over a wide range of operating conditions.

Other Geometric Arrangements

Geometric arrangements other than those shown in FIG. 2 to 6 may proveto be desirable. FIGS. 7a and 7b illustrate one such arrangementdesigned to give a short hydraulic path. Numerals the same as those usedin FIGS. 1 to 6 have been employed. FIG. 7a is a top view and FIG. 7b isa side view. The actuator 11 is controlled by control electronics 3 tocause hydraulic fluid to flow from volume displacement chamber 17 tocause blood in blood chamber 15 to be pumped entering at inflow bloodport 19 ad exiting at outflow blood port 17.

FIG. 8a is a top view and FIG. 8b is a side view of another geometricconfiguration in which the control electronics 3 is located betweenblood chamber 15 and volume displacement chamber 17.

FIG. 9 is a perspective view of a configuration where the blood chamber15 is adjacent to volume displacement chamber 17 both of which areapproximately arcuately shaped.

I claim:
 1. A unified system for use in a ventricular assist device andfor total implantation in a thorax of a patient for cannulation to theblood circulatory system to replace or assist a ventricle of a naturalheart of the patient, said unified system comprising:an internalelectronic controller for generating an actuating signal; a bloodpumping means provided proximate to said internal electronic controller,said blood pumping means comprising:a blood pumping chamber comprising:ablood compartment having an inflow blood port and an outflow blood portfor cannulation to the blood circulatory system; a fluid compartment forreceiving a fluid; and a flexible membrane separating said bloodcompartment and said fluid compartment; a volume displacement chamberfor receiving the fluid; a fluid conduit connecting said blood pumpingchamber and said volume displacement chamber to allow flow of the fluidbetween said blood pumping chamber and said volume displacement chamber;and an actuating means, provided in said fluid conduit, for convertingsaid actuating signal into a pulsating rhythmic displacement of thefluid between said blood pumping chamber and said volume displacementchamber through said fluid conduit and said actuating means; whereinsaid actuating means is provided proximate to said internal electroniccontroller, said blood pumping chamber and said volume displacementchamber so that said unified system has a shape with a convex backsurface having a curvature compatible with curvatures of an internalhuman sagittal and transverse chest wail, and an overall size andgeometry such that, when the unified system is implanted in the patient,said unified system is accommodated within the thorax with the backsurface of said unified system adjacent the chest wall without adverselycompressing adjacent organs, creating dead space or limiting chestclosure.
 2. A unified system as claimed in claim 1, wherein the backsurface of said unified system has longitudinal curvature complementaryto a sagittal radius of 11±0.5 cm and a transversal curvaturecomplementary to an intrathoracic wall having a radius of 9.4±0.5 cm. 3.A unified system as claimed in claim 2 in which the average transversalradius of curvature of the back of said unified system is 10±2 cm andthe average longitudinal radius of curvature is 22±5 cm.
 4. A unifiedsystem as claimed in claim 1, wherein said blood ports are equipped withone-way valves to ensure unidirectional flow of blood from the naturalheart through said blood chamber to the systemic and/or pulmonarycirculation systems.
 5. A unified system as claimed in claim 1, furthercomprising an inflow cannula connected to said inflow port and anoutflow cannula connected to said outflow port for cannulation with theblood circulatory system.
 6. A unified system as claimed in claim 5,wherein said inflow port is oriented at a longitudinal angle A₃ between25° and 140° and at a transversal angle A₁ between 25° and 140° withrespect to longitudinal and transverse centre lines respectively of saidunified system, so as to minimize the distance between said inflow portand the systemic or pulmonary circulation when the unified system isimplanted in the thorax for assisting or replacing a respectiveventricle and in which none of said angles makes the axis of the inflowport perpendicular to said membrane.
 7. A unified system as claimed inclaim 5 in which A₁ is 35°±10° and A₃ is 130°±10°.
 8. A unified systemas claimed in claim 7 in which A₁ is 35°±10° and A₂ is 20°±10°.
 9. Aunified system as claimed in claim 5, wherein the length of said outflowcannula is between 5 and 14 cm.
 10. A unified system as claimed in claim5, wherein said outflow port is oriented at a longitudinal angle A₂between 10° and 140° and at a transversal angle A₁ between 25° and 140°with respect to longitudinal and transversal centre lines respectivelyof said unified system, so as to minimize the distance between saidoutflow port and the systemic or pulmonary circulation when the unifiedsystem is implanted in the thorax for assisting or replacing arespective ventricle.
 11. A unified system as claimed in claim 5,wherein the length of said inflow cannula is between 1 and 5 cm.
 12. Aunified system as claimed in claim 1, having an overall thickness ofless than 4 cm.
 13. A unified system as claimed in claim 1, having anoverall length less than 18 cm.
 14. A unified system as claimed in claim1, having an overall width less than 12 cm.
 15. A unified system asclaimed in claim 1, wherein said inflow port is provided with a firstone way valve which allows entry of blood into said blood compartmentand said outflow port is provided with a second one-way valve whichallows ejection of the blood from said blood compartment.
 16. A unifiedsystem as claimed in claim 1, wherein the stroke volume of said bloodpumping chamber is between 55 and 70 ml.
 17. A unified system as claimedin claim 1, giving a cardiac output of greater than 3 liters/minute witha mean preload pressure of between 5 to 10 mm Hg and an afterloadpressure greater than 100 mm Hg.
 18. A unified system as claimed inclaim 1, wherein said actuating means comprises:a brushless DC motor forreceiving said actuating signal and converting it into a forward andreverse rotational movement; a reversible axial pump for converting saidrotational movement into said back and forth displacement of fluid todisplace said flexible membrane between systolic and diastolicpositions.
 19. A unified system as claimed in claim 18, wherein saidmotor and said pump form a unitary energy convertor.
 20. A unifiedsystem as claimed in claim 19, wherein said fluid further acts as alubricant for bearings in said energy convertor and as means to disperseheat from the actuating means and the internal electronic controllerthroughout the device to minimize tissue necrosis due to heat.
 21. Aunified system as claimed in claim 18, comprising detecting means fordetecting the systolic or diastolic position of said flexible membraneand for accordingly generating a control signal to said internalelectronic controller for synchronizing said actuating signal with thedisplacement of said flexible membrane.
 22. A unified system as claimedin claim 21, wherein said detector is an infrared sensor.
 23. A deviceas claimed in claim 1, further comprising means for securing saidsupport to a rib cage to prevent migration and the resulting organcompression.
 24. A unified system as claimed in claim 1 furthercomprising a support for said internal electronic controller and saidblood pumping means so that said inflow and outflow ports are orientedaway from a front surface of said unified system.
 25. A unified systemas claimed in claim 1, wherein said blood pumping chamber converts saidpulsating rhythmic displacement of the fluid into a rhythmicunidirectional displacement of blood into and from said bloodcompartment through said inflow and outflow ports.
 26. A unified systemas claimed in claim 1, wherein said internal electronic controller has afirst set of conductors for providing said internal electroniccontroller with a supply voltage, and said unified system furthercomprises a feedthrough cover for hermetic trespass of said first set ofconductors.
 27. A unified system as claimed in claim 26, wherein saidfeedthrough cover further comprises a fluid port for filling said volumedisplacement chamber, said fluid compartment and said fluid conduit withfluid.
 28. A unified system as claimed in claim 1, whereinsaid bloodpumping chamber comprises a generally flat oval sac defining a back faceand a front face, and said inflow and outflow ports protrude from saidfront face; said flexible membrane divides said sac longitudinally todefine said blood compartment between said front face and said flexiblemembrane, and said fluid compartment between said flexible membrane andsaid back face; said flexible membrane oscillates between a systolicposition, to displace blood from blood compartment into the circulatorysystem, and a diastolic position, to fill up said blood compartment withblood from the circulatory system; said pulsating rhythmic displacementof the fluid generates said oscillating displacement of said flexiblemembrane between said systolic position, where the fluid is displaced insaid fluid compartment, and said diastolic position, where the fluiddrains off said fluid compartment.
 29. A unified system for use in aventricular assist device and for total implantation in a thorax of apatient for cannulation to the blood circulatory system to replace orassist a ventricle of a natural heart of the patient, said unifiedsystem comprising:an internal electronic controller for generating anactuating signal; a blood pumping means provided proximate to saidinternal electronic controller, said blood pumping means comprising:ablood pumping chamber comprising:a blood compartment having an inflowblood port and an outflow blood port for cannulation to the bloodcirculatory system; a fluid compartment for receiving a fluid; and aflexible membrane separating said blood compartment and said fluidcompartment; a volume displacement chamber for receiving the fluid; afluid conduit connecting said blood pumping chamber and said volumedisplacement chamber to allow flow of the fluid between said bloodpumping chamber and said volume displacement chamber; and an actuatingmeans, provided in said fluid conduit, for converting said actuatingsignal into a pulsating rhythmic displacement of the fluid between saidblood pumping chamber and said volume displacement chamber through saidfluid conduit and said actuating means; hermetic coupling means forproviding said internal electronic controller with a supply voltage; anddetecting means for detecting the status of said blood pumping chamberand accordingly generating a control signal to said internal electroniccontroller for synchronizing said actuating signal with the status ofsaid blood pumping chamber; wherein said actuating means is providedproximate to said internal electronic controller, said blood pumpingchamber and said volume displacement chamber so that said unified systemhas a shape with a convex back surface having a curvature compatiblewith curvatures of an internal human sagittal and transverse chest wall,and an overall size and geometry such that, when the unified system isimplanted in the patient, said unified system is accommodated within thethorax with the back surface of said unified system adjacent the chestwall without adversely compressing adjacent organs, creating dead spaceor limiting chest closure.